Acute contained ruptured aortic aneurysm presenting as left vocal fold immobility

Area of Science:

• Cardiology
• Otolaryngology
• Vascular Surgery

Background:

• Ortner's syndrome (cardiovocal syndrome) links cardiovascular pathology to recurrent laryngeal nerve palsy.
• Vocal fold immobility can be an atypical presentation of cardiovascular emergencies.

Purpose of the Study:

• To identify intrathoracic abnormalities, specifically aortic aneurysms, as a cause of acute vocal fold immobility.
• To present a case of acute contained ruptured aortic aneurysm presenting as sudden hoarseness.

Main Methods:

• Case report of an 85-year-old female with sudden onset hoarseness.
• Laryngoscopy and CT scan to diagnose vocal fold immobility and aortic pathology.
• Literature review on Ortner's syndrome and cardiovascular causes of vocal cord dysfunction.

Main Results:

• The patient presented with left vocal fold immobility.
• CT revealed an acute contained ruptured aortic aneurysm with a large hematoma.
• Vocal fold immobility was treated with injection medialization, improving voice quality.
• Hematoma size reduced on follow-up CT, but vocal cord remained immobile.

Conclusions:

• Acute aortic aneurysm rupture can manifest as acute vocal fold immobility.
• Prompt diagnosis and consideration of cardiovascular pathology are crucial for patients with sudden hoarseness.
• While often gradual, Ortner's syndrome can present acutely, necessitating urgent medical evaluation.